A clinical and longitudinal study of relationship between family systems and a mental health problem of aging is proposed in this new grant application. This study will examine patterns of stress in community caregivers who provide home care to elderly relatives with chronic brain disease. The study approaches dementia as a process which affects all members of the family unit, and investigates how family system characteristics mediate the impact of the disease on caregivers and patient alike. Ninety families providing home care for an elderly relative with dementia, and a comparison group of 30 families in which a normal elderly relative resides, will be evaluated and followed longitudinally, with reevaluation at 12 months, and follow-up by mailed self report assessment measures at 6 and 18 months. Half of the families in each group will feature a same-generation patient-caregiver relationship, and half a cross-generational one. In each family, measures of social role functioning, physical and mental health, and subjectively experienced strain will be obtained from the primary caregiver and one or more other family members. The extent and behavioral manifestations of dementia in the elderly relative will be evaluated via neuropsychological testing, family interviews and a psychiatric evaluation, so as to specify cognitive deficits, problem behaviors, and deficiencies in daily functioning. A number of current and historical factors in the family system will be assessed as potential predictors of the disease's impact on other family members and, reciprocally, of the patient's own maintenance of function over time. The research focuses especially on interpersonal factors such as traditional family loyalties and past relationships between patient and caregiver (background factors), characteristics of the extrafamilial socal network (resource factors), and elements of family cohesion and adaptability (current interaction pattern factors). This study will clarify how the family system influences changes in both caregivers and dementia patients over the progressive courses of chronic brain disease, and will identify coping patterns and other critical factors which predict better outcomes, generating hypotheses to be tested in subsequent phases of a planned, long-range research program.